My nurse tied a resident in here wheelchair

  1. Night before last I was alone on the Alzhiemers unit, my partner was on lunch and the housekeeper was cleaning on the unit. I was washing my hands in the medicine room when she came and got me and told me that one of the residents was in the floor. I went and checked the resident for injuries and deformities. I then called the front desk and had them send the nurse over to my unit. The Alzhiemers unit and ICF/PCF unit share a nurse, we have a CMA and two CNAs that work on the alzhiemers unit. The nurse, an agency nurse I don't know, came over in about a minute. She checked her and made sure that nothing was falling off, etc. We then helped the resident out of the floor. We put her in the wheelchair and I put her lapbuddy on and while I was putting the Lapbuddy on the nurse took the sheet that I had intended to use to cover her legs and tied her in the wheelchair. I was in shock, she said something about making sure that I untied her before the next shift showed up. She went back to the PCF/ICF unit and did the incident report. As she was leaving the unit my partner was returning from lunch. I showed her what the nurse had done. We took her and untied her and layed her down to sleep. I told my supervising nurse the next night what had happened and she said that she didn't want to know about it. Today however the DON and Social Work were running around asking questions about the night before last. Apparently the nurse had told the CNAs to do it to a resident on the skilled unit. The refused and went to the administrator who yelled at the nurse saying that she had better not ever hear of her doing it again. Since no one that I told told their supervisor it looks like I am lying and they may say that I never told them to cover their butts. If I could go back I would have called the administrator at home but whats done is done. Everyone is going to say that I should document to cover my a$s but we have no where to document. CNAs are not allowed to chart in the charts. The nurse that I told didn't report it to anyone. The Occupational Therapist is my witness that I told a nurse. The bad part is that it was almost 19 hours after the origional incident. Despite all of this when asked if she had tied a resident to a chair the nurse said that "she" had not tied anyone down. Well, lets see who does that leave.......oh yeah, me!:angryfire I am so angry right now and I am so sorry that I didn't report it sooner. I thought we had mentioned it to the CMA but I called tonight and asked and she said that we hadn't mentioned it to her. I told the DON what I had witnessed today and she sent me to the acting administrator who I told, she told me to write out a statement of what I had told her. I am terrified that my job is in jeopardy and that because of my stupidity the facility has been opened up to tons of liability. The company that is managing the facility has said that there are somethings that are making them consider pulling out of the sale. The facility was out of money when they took over, if they hadn't we wouldn't have gotten paid for the last month. They have told us that if at all possible that they would stay and close sale on the facility but that some issues have been coming up like a thing with an agency nurse that made them feel like we may not be the best investment. They are talking about what happened with me. I am worried that I have helped my 130 residents lose their home and my coworkers may lose their jobs. I am worried sick . I want my facility to stay open and I want the residents to feel safe in their facility. I want my job and I am afraid that if we don't close, that they may fire me. Any advice, remember I have no way to document. CNAs dont chart.
    Last edit by Chad_KY_SRNA on Jun 16, '04
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  2. 26 Comments

  3. by   tattooednursie
    That is definantly a cruddy situation to be in. If you see something like that again, you don't have to put it in the chart. Just write up everything you saw, heard, and exactly what that nurse did on a blank peice of paper and slip it under the DON's door. Also, call the local Obmudsman ASAP after the incident. Writing it up now probably wouldn't hurt either. Were there any witnesses to this situation? Anyone? Even if it was just the housekeeper. Ask them if they saw anything at all.

    I hope everything works out for you.
    Mandi
  4. by   tattooednursie
    And be sure to call the Ombudsman on this situation. The # should be posted all over the facility.
  5. by   Younessian
    As an experienced charge nurse I have had to write "nursing office" reports after the fact. Sometimes we find out later there was a problem. It sounds like you did what you should have in writing everything you remember about the incident. Make sure to include everyone present and the sreps you made to rectify the situation. It sounds like you really care about your patients and don't be intimidated by the nurses if you know something is wrong. Good luck

    Quote from Chad_KY_SRNA
    Night before last I was alone on the Alzhiemers unit, my partner was on lunch and the housekeeper was cleaning on the unit. I was washing my hands in the medicine room when she came and got me and told me that one of the residents was in the floor. I went and checked the resident for injuries and deformities. I then called the front desk and had them send the nurse over to my unit. The Alzhiemers unit and ICF/PCF unit share a nurse, we have a CMA and two CNAs that work on the alzhiemers unit. The nurse, an agency nurse I don't know, came over in about a minute. She checked her and made sure that nothing was falling off, etc. We then helped the resident out of the floor. We put her in the wheelchair and I put her lapbuddy on and while I was putting the Lapbuddy on the nurse took the sheet that I had intended to use to cover her legs and tied her in the wheelchair. I was in shock, she said something about making sure that I untied her before the next shift showed up. She went back to the PCF/ICF unit and did the incident report. As she was leaving the unit my partner was returning from lunch. I showed her what the nurse had done. We took her and untied her and layed her down to sleep. I told my supervising nurse the next night what had happened and she said that she didn't want to know about it. Today however the DON and Social Work were running around asking questions about the night before last. Apparently the nurse had told the CNAs to do it to a resident on the skilled unit. The refused and went to the administrator who yelled at the nurse saying that she had better not ever hear of her doing it again. Since no one that I told told their supervisor it looks like I am lying and they may say that I never told them to cover their butts. If I could go back I would have called the administrator at home but whats done is done. Everyone is going to say that I should document to cover my a$s but we have no where to document. CNAs are not allowed to chart in the charts. The nurse that I told didn't report it to anyone. The Occupational Therapist is my witness that I told a nurse. The bad part is that it was almost 19 hours after the origional incident. Despite all of this when asked if she had tied a resident to a chair the nurse said that "she" had not tied anyone down. Well, lets see who does that leave.......oh yeah, me!:angryfire I am so angry right now and I am so sorry that I didn't report it sooner. I thought we had mentioned it to the CMA but I called tonight and asked and she said that we hadn't mentioned it to her. I told the DON what I had witnessed today and she sent me to the acting administrator who I told, she told me to write out a statement of what I had told her. I am terrified that my job is in jeopardy and that because of my stupidity the facility has been opened up to tons of liability. The company that is managing the facility has said that there are somethings that are making them consider pulling out of the sale. The facility was out of money when they took over, if they hadn't we wouldn't have gotten paid for the last month. They have told us that if at all possible that they would stay and close sale on the facility but that some issues have been coming up like a thing with an agency nurse that made them feel like we may not be the best investment. They are talking about what happened with me. I am worried that I have helped my 130 residents lose their home and my coworkers may lose their jobs. I am worried sick . I want my facility to stay open and I want the residents to feel safe in their facility. I want my job and I am afraid that if we don't close, that they may fire me. Any advice, remember I have no way to document. CNAs dont chart.
  6. by   Rapheal
    I hope everything works out for you. I do not think that you should carry the burden of believing that what you did or failed to do will cost the residents their home. There potential new owners are not going to make their decision based on just that alone. Good luck.
  7. by   stevierae
    Quote from Chad_KY_SRNA
    I am worried that I have helped my 130 residents lose their home and my coworkers may lose their jobs. I am worried sick . I want my facility to stay open and I want the residents to feel safe in their facility. I want my job and I am afraid that if we don't close, that they may fire me. Any advice, remember I have no way to document. CNAs dont chart.
    You are a very caring person, and will make a phenomenal nurse if that is your goal. No one only 18 years old should have this horrible situation weighing on her mind! I would worry no more. If you haven't already written it down (actually, you have, here) do just in case it comes up and you are pulled in for a discussion with whomever. Just tell the truth. The nurse that put you in that situation should not be practicing. She will not come across as credible if she tries to put the blame on anyone but herself, and it sounds as if she has already done just that. She has probably gotten herself in hot water before; I guarantee you this was not an isolated incident.

    Also, the nurse that didn't want to hear about it shares some of the burden, too. Not you. You did everything in your power that you knew to do.

    I would tell the DON that if she threatens to fire you, when you did absolutely nothing wrong, you will tell the family about what occurred, and you will go to the media, and you will name names--not only of the nurse that did the tying, but of the agency that employs HER, and of the nurse you tried to tell who "didn't want to hear about it." And DEFINITELY, as suggested, call the ombudsman.

    Those residents are lucky to have you looking out for them. All nursing home residents should be so lucky.

    Keep us informed. I think you hav enothing to worry about. it is obvious you would never do such a thing to a resident, never have before, and the people who work with you know your history and will stand up for you. This is NOT your fault. Know this. You did NOTHING wrong.
    Last edit by stevierae on Jun 16, '04
  8. by   Destinystar
    you do not need anyones permisson, but call
    1. the nursing registry where this nurse came from
    2. the licensing board where this nurse got her license from
    3. the health department for elder abuse
    4. you can also call the dons rn license board and the administrator board for not reporting this as soon as they found out
    5. during orientation did anyone give you a policy to read and sign about pt abuse
    6. we are all mandated reporters
    7. it is not your responsibility to make sure management takes care of these residents. it is your responsibility to take care of yourself. please get out of there before one more thing happens. you dont deserve to be in a situation like this. the people who are running this place sound like they are walking all over you.
    Quote from chad_ky_srna
    night before last i was alone on the alzhiemers unit, my partner was on lunch and the housekeeper was cleaning on the unit. i was washing my hands in the medicine room when she came and got me and told me that one of the residents was in the floor. i went and checked the resident for injuries and deformities. i then called the front desk and had them send the nurse over to my unit. the alzhiemers unit and icf/pcf unit share a nurse, we have a cma and two cnas that work on the alzhiemers unit. the nurse, an agency nurse i don't know, came over in about a minute. she checked her and made sure that nothing was falling off, etc. we then helped the resident out of the floor. we put her in the wheelchair and i put her lapbuddy on and while i was putting the lapbuddy on the nurse took the sheet that i had intended to use to cover her legs and tied her in the wheelchair. i was in shock, she said something about making sure that i untied her before the next shift showed up. she went back to the pcf/icf unit and did the incident report. as she was leaving the unit my partner was returning from lunch. i showed her what the nurse had done. we took her and untied her and layed her down to sleep. i told my supervising nurse the next night what had happened and she said that she didn't want to know about it. today however the don and social work were running around asking questions about the night before last. apparently the nurse had told the cnas to do it to a resident on the skilled unit. the refused and went to the administrator who yelled at the nurse saying that she had better not ever hear of her doing it again. since no one that i told told their supervisor it looks like i am lying and they may say that i never told them to cover their butts. if i could go back i would have called the administrator at home but whats done is done. everyone is going to say that i should document to cover my a$s but we have no where to document. cnas are not allowed to chart in the charts. the nurse that i told didn't report it to anyone. the occupational therapist is my witness that i told a nurse. the bad part is that it was almost 19 hours after the origional incident. despite all of this when asked if she had tied a resident to a chair the nurse said that "she" had not tied anyone down. well, lets see who does that leave.......oh yeah, me!:angryfire i am so angry right now and i am so sorry that i didn't report it sooner. i thought we had mentioned it to the cma but i called tonight and asked and she said that we hadn't mentioned it to her. i told the don what i had witnessed today and she sent me to the acting administrator who i told, she told me to write out a statement of what i had told her. i am terrified that my job is in jeopardy and that because of my stupidity the facility has been opened up to tons of liability. the company that is managing the facility has said that there are somethings that are making them consider pulling out of the sale. the facility was out of money when they took over, if they hadn't we wouldn't have gotten paid for the last month. they have told us that if at all possible that they would stay and close sale on the facility but that some issues have been coming up like a thing with an agency nurse that made them feel like we may not be the best investment. they are talking about what happened with me. i am worried that i have helped my 130 residents lose their home and my coworkers may lose their jobs. i am worried sick . i want my facility to stay open and i want the residents to feel safe in their facility. i want my job and i am afraid that if we don't close, that they may fire me. any advice, remember i have no way to document. cnas dont chart.
  9. by   mattsmom81
    It used to be common practice to use a sheet restraint to keep a confused patient in a bed or chair. It was done to keep them safe/prevent falling etc.. It is a nono NOW, however...but a nurse that infrequently works or doesn't do LTC may not be completely aware of that and may have fallen back into 'bad habits' . You state this nurse was an agency nurse. Perhaps she was not familiar with the current laws , as well as PP's, and hopefully somebodytook a moment to point this out to her before 'writing her up'.

    I think agency staff can get royally dumped on and made scapegoats in facilities and I hope some education deficit was considered before all the wrath descended upon her. <sigh> I occasionally take a perdiem agency shift in a LTC but am in no way an expert on all the current laws, although I try to keep up. I would hope a coworker would understand that and help me out if i did something that wasn't kosher.

    Maybe I'm off base here, but I like to see honest communication take place prior to the bells and whistles and calling the big dogs in to point a finger. There's too much finger pointing, backstabbing, etc. in nursing already, far too much competition and one upsmanship among staff members IMO.
  10. by   stevierae
    Quote from mattsmom81
    It used to be common practice to use a sheet restraint to keep a confused patient in a bed or chair. It was done to keep them safe/prevent falling etc.. It is a nono NOW, however...but a nurse that infrequently works or doesn't do LTC may not be completely aware of that and may have fallen back into 'bad habits' . You state this nurse was an agency nurse. Perhaps she was not familiar with the current laws , as well as PP's, and hopefully somebodytook a moment to point this out to her before 'writing her up'.
    I remember those days, too, and also remember when Poseys and 4 point restraints were not all that uncommon--but I don't buy that, in this day and age, ANY nurse would be unaware of how dramatically the rules involving restraints have changed. Everywhere you go, every nursing magazine you pick up, it's a hot topic. I am an operating room nurse, and I know it. Even when I did IV teaching, I knew it--no matter what facility I was working in, there were brochures, CE classes, bulletins from JCAHO posted prominently on the bulletin boards, etc. In fact, when I work registry, we have to take a test every year going over new changes that may or may not affect us, and restraints are always included.
    Last edit by stevierae on Jun 16, '04
  11. by   ktwlpn
    Quote from mattsmom81
    It used to be common practice to use a sheet restraint to keep a confused patient in a bed or chair. It was done to keep them safe/prevent falling etc.. It is a nono NOW, however...but a nurse that infrequently works or doesn't do LTC may not be completely aware of that and may have fallen back into 'bad habits' . You state this nurse was an agency nurse. Perhaps she was not familiar with the current laws , as well as PP's, and hopefully somebodytook a moment to point this out to her before 'writing her up'.

    I think agency staff can get royally dumped on and made scapegoats in facilities and I hope some education deficit was considered before all the wrath descended upon her. <sigh> I occasionally take a perdiem agency shift in a LTC but am in no way an expert on all the current laws, although I try to keep up. I would hope a coworker would understand that and help me out if i did something that wasn't kosher.

    Maybe I'm off base here, but I like to see honest communication take place prior to the bells and whistles and calling the big dogs in to point a finger. There's too much finger pointing, backstabbing, etc. in nursing already, far too much competition and one upsmanship among staff members IMO.
    In this case I believe that nurse knew that what she was doing was very wrong as evidenced by her remark to the poster regarding untying the resident before the next shift arrived....If this type of thing is used as an excuse to back out of buying the home you can be sure that it is just a convenient and "reasonable" excuse and they for sure have other reasons..but may use this type of thing for effect...You did what was right for all of the residents
  12. by   Dixiedi
    Quote from stevierae
    I remember those days, too, and also remember when Poseys and 4 point restraints were not all that uncommon--but I don't buy that, in this day and age, ANY nurse would be unaware of how dramatically the rules involving restraints have changed. Everywhere you go, every nursing magazine you pick up, it's a hot topic. I am an operating room nurse, and I know it. Even when I did IV teaching, I knew it--no matter what facility I was working in, there were brochures, CE classes, bulletins from JCAHO posted prominently on the bulletin boards, etc. In fact, when I work registry, we have to take a test every year going over new changes that may or may not affect us, and restraints are always included.
    Remember when we onlly needed an order for leather? Any kind of soft restraint could be used at the nurses descretion and it was often so horrid that I was sickened by it. I, for one did a dance for joy when "they" could no longer tie down a human being for no really good reason other than it was easier on the staff to keep the pt safe! Bull hockey!
  13. by   mattsmom81
    Hmm. Well have ya'll been in a situation where you didn't HAVE a posey, chair restraint or wrist restraint immediately available? (Guess nobody here works for HCA or places like that...LOL)

    Sometimes we improvise for a time. If someone is gonna fall or pull a line and hurt themselves and you'll be liable for something either way, we sometimes have to make choices. I don't know WHY this nurse did what she did...I just object to the whistle blowing and finger pointing before a reminder face to face. That may have been all it took...someone saying "You know, we really can't do this anymore...let me go find the proper equipment and we'll talk about it later".

    I primarily do ICU where I WILL be liable if the patient hurts themselves so we sometimes make choices based on this knowledge. Its not a policy nor best practice to use sheet restraints, but I HAVE in extreme circumstances UNTIL I could find appropriate equipment.
  14. by   Dixiedi
    Quote from mattsmom81
    Hmm. Well have ya'll been in a situation where you didn't HAVE a posey, chair restraint or wrist restraint immediately available? (Guess nobody here works for HCA or places like that...LOL)

    Sometimes we improvise for a time. If someone is gonna fall or pull a line and hurt themselves and you'll be liable for something either way, we sometimes have to make choices. I don't know WHY this nurse did what she did...I just object to the whistle blowing and finger pointing before a reminder face to face. That may have been all it took...someone saying "You know, we really can't do this anymore...let me go find the proper equipment and we'll talk about it later".

    I primarily do ICU where I WILL be liable if the patient hurts themselves so we sometimes make choices based on this knowledge. Its not a policy nor best practice to use sheet restraints, but I HAVE in extreme circumstances UNTIL I could find appropriate equipment.
    I don't know the situation where the CNA is talking about. However, if I had to generalize a larage facility, short on help , her choice may well have been the best choice. After all, the pt was found on the floor!
    I was talking about just the generalized use of retraints years ago when even little old ladies who would reach out and catch your hand or shirt tail as you walked by trying to get your attention were tied down. THAT I am glad is a thing of the past.
    Retraints, properly used are, I believe a good thing. It's a nursing decision and any one who objects needs to find out what the nurses reasoning was before they speak poorly of her. I will note the nurse did tie the restraint herself, she did not instruct the CNA to do it.

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